Abstract
We developed a hinged external fixator for the treatment of dislocated intra-articular
calcaneus fractures with severe soft tissue damage. The external fixation was performed
with a known external fixator system. The screw insertion points were biomechanically
tested by defining a virtual rotation axis through the center of the talus to allow
early active motion in the ankle joint. Long-term follow-up was performed after an
average of 7.3 years. Results were graded with the American Orthopaedic Foot and Ankle
Society (AOFAS) score. Radiographs were reviewed according to Sanders classification.
Four open fractures and 33 cases with extremely swollen soft tissue, blisters, or
compartment syndromes were treated. In 24 cases (64.9%), the hinged fixator was the
final method of treatment (group I). A change to open reduction with internal fixation
was performed in 13 fractures (35.1%) when soft tissue problems were minimal (group
II). There were no late amputations, osteomyelitis, or malunions. According to Sanders
classification, group I consisted of 14 type II, 8 type III, and 2 type IV fractures.
Pin loosening or pin infection was seen in 4 cases, but there was no redislocation.
The Böhler's angle improved in 43%, gaps in the posterior facet were closed in 41%,
and any shortening or deviation of the axis was corrected in 82% of the cases. The
AOFAS score for the group averaged 66.5. According to Sanders classification, group
II consisted of 8 type II and 5 type III fractures. The Böhler's angle improved in
88%, and gaps in the posterior facet were closed in 87%. Any shortening or deviation
of the axis was corrected in 95%, and the AOFAS score averaged 61.3. Significant differences
in patient outcome scores between open reduction with internal fixation and hinged
fixator were not found. P value was > .05. The hinged external fixator frame can be used in all calcaneus fracture
types without soft tissue limitation. The hinged fixator allows early movement in
the ankle joint, the risk of infection is minimized, and secondary plate fixation
remains possible.
Level of Clinical Evidence
Keywords
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Article info
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
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© 2010 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.